Anti-overdose drug Narcan still not widely used by first responders

Narcan, a substance that can reverse the effects of heroin and medical opiates, is saving lives. It is effective, easy to administer and cheap. So why isn't everyone using it?

Paramedics from the Stoughton Fire Department were called to the scene of a double overdose last month in the men’s room of a local restaurant.

They quickly administered Narcan, a substance that can reverse the effects of heroin and medical opiates such as Oxycontin, morphine and codeine, which are derived from chemicals similar to opium from the poppy plant. Both of the victims survived, said Stoughton Fire Chief Mark Dolloff.

In 2013, the Stoughton Fire Department used Narcan 36 times in response to drug overdoses. All 36 people lived, Dolloff said. In 2012, Narcan was used 29 times in response to drug overdoses, and all 29 of those people also lived, he said.

Narcan is saving lives. It is effective, easy to administer and cheap. There are two programs in Brockton that provide training and free Narcan for anyone 18 or older. With 20 minutes of training anybody can use it. So why isn’t everyone using it?

Doctors, rehab experts and lawmakers say there is a combination of issues that inhibits widespread use of Narcan including morality, the federal rules and the overwhelming number of overdoses. According to the Centers for Disease Control, 105 people die every day in the United States from drug overdoses involving heroin or pharmaceutical opioids.

“There is a stigma attached to substance abuse and that may be driving some politicians to not endorse funding or provide any intervention for Narcan,” said Dr. Joseph Shrand, medical director of CASTLE (Clean And Sober Teens Living Empowered), part of the High Point Treatment Center in Brockton.

“People don’t want to pay for people with addictions. They think it is a moral issue,” Shrand said. “They say, they knew what they were doing and why should I have to pay for them?”

Another part of the resistance to Narcan is that people simply are not aware of the overwhelming scope of the heroin epidemic, he said.

Stephanie Patton is the prevention coordinator at OASIS (Organizing Against Substances In Stoughton), a federally funded substance abuse prevention coalition.

“The stigma definitely exists, but research has shown that providing Narcan doesn’t increase the use of opiates,” Patton said. “Narcan does save lives and presents another chance for them to seek help.”

Narcan is the brand name for the generic drug naloxone. One of the effects of heroin and other opiates is to depress breathing, to depress breathing dangerously. They produce this and other effects by acting on special receptors in the brain and nervous system. Spraying Narcan into the nostrils or injecting it intravenously blocks these opioid receptors and reverses the effects of the drug.

The Stoughton Police Department trained to use a nasal form of Narcan in December and officers now carry it in their cruisers. Stoughton’s Fire Department paramedics administer Narcan intravenously.

Fire departments in Easton, Bridgewater, East Bridgewater, West Bridgewater, Hanson and Whitman also use Narcan.

But Narcan is not yet in the hands of all first responders, including the area’s largest fire department – Brockton.

That situation will change very soon.

“The Narcan has been ordered and will be here shortly,” Brockton Fire Chief Richard Francis said this past week. The 180 Brockton firefighters and staff will be trained to administer nasal Narcan. Francis estimated Narcan would begin being used in fewer than 10 days. Brockton has had three suspected overdose deaths in the past week.

“It’s at a crisis stage now that overdoses are happening so much more,” Francis said.

Although not in the hands of emergency responders or police, Narcan has been in use in Brockton starting in 2008, when it was handed out to parents as part of a pilot program aimed at reducing opiate deaths.

Brockton Mayor Bill Carpenter is pushing to get Narcan more widely distributed. He directed Francis to get Narcan training for the Fire Department. The mayor said he is also planning to hold a forum on the current overdose situation.

“Narcan works. It’s a miracle when someone is dying of an overdose,” Carpenter said. “We need to address this drug crisis as a community and people need to put their judgments aside.”

The Enterprise found back in 2008 that heroin had been taking an increasing deadly toll in Brockton and Taunton by examining death certificates. The review found 113 people died of opiate overdoses in those communities between 2004 and 2007. The deaths were detailed in two special reports, “Wasted Youth” and “Deadly Surge” published in 2007.

Quincy police officers have been using Narcan for more than three years.

“Since 2010, we reversed 222 overdoses,” said Quincy Police Lt. Patrick Glynn, the commander of the drug control unit.

The federal Food and Drug Administration – which still treats Narcan as a prescription drug – is slowing down its distribution, said Michael Morrissey, the Norfolk County District Attorney.

“Getting the FDA to declassify Narcan as a prescription drug might be the biggest single hold-up to getting it into the hands of the public,” Morrissey said.

He has been in Washington recently meeting with lawmakers, urging them to try and move forward a petition on the declassification.

“It’s a problem when people’s lives are at stake. I wish people would move faster and I wish the FDA would move faster,” Morrissey said.

On March 26, Morrissey plans to hold a training session for first responders who are interested in learning how to use Narcan.

“If we can put Narcan in the hands of first responders, then we should,” said Brockton state Rep. Christine Canavan, who in the past worked as a registered nurse. “That’s what makes us a just and fair society, the fact that we value life.”

In Quincy, the use of Narcan reduced deaths from drug overdoses by 67 percent in the first 18 months it was deployed, said Lt. Glynn.

“We have had such positive feedback with this program in Quincy,” said state Sen. John Keenan, who chairs the Legislature’s Joint Committee on Public Health.

He said other communities may be taking a wait-and-see approach as they watch Quincy’s pilot program undertaken with the state’s Department of Public Health.

It could also be that many communities don’t realize the cost of Narcan and the training.

According to Stephanie Patton with OASIS, Narcan costs the Stoughton organization $30.89 a unit.

The OASIS staff puts together Narcan kits for the Stoughton Police Department. Two doses of Narcan as well as the spray bottles for nasal distribution are included in the kit, which cost $66 each, Patton said.

It cost the Quincy Police Department $10,000 to use Narcan in 222 drug overdoses and every person lived, Glynn said. That works out to $45.05 each time it was used.

“It’s not really a budget-buster for anyone,” Glynn said.

“We have to hit this problem head-on and we realized we can’t arrest our way out of this situation,” he said. “It really is a miracle drug.”

Jennifer Bray may be reached at jbray@enterprisenews.com or follow her on Twitter @JenniferB_ENT.